Subperiosteal vs Subdural Drain After Burr-Hole Drainage of Chronic Subdural Hematoma: A Randomized Clinical Trial (cSDH-Drain-Trial)

被引:95
作者
Rabb, Craig H.
Kaliaperumal, Chandrasekaran
机构
[1] Department of Neurosurgery, Kantonsspital Aarau, Aarau
[2] Department of Neurosurgery, University Hospital of Basel, Spitalstrasse 21, Basel
[3] Clinical Trial Unit, University Hospital of Basel, Basel
关键词
Burr-hole drainage; Chronic subdural hematoma; Subdural drain; Subperiosteal drain; Traumatic brain injury;
D O I
10.1093/neuros/nyz095
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: The use of a subdural drain (SDD) after burr-hole drainage of chronic subdural hematoma (cSDH) reduces recurrence at 6 mo. Subperiosteal drains (SPDs) are considered safer, since they are not positioned in direct contact to cortical structures, bridging veins, or hematoma membranes. OBJECTIVE: To investigate whether the recurrence rate after insertion of a SPD is noninferior to the insertion of a more commonly used SDD. METHODS: Multicenter, prospective, randomized, controlled, noninferiority trial analyzing patients undergoing burr-hole drainage for cSDH aged 18 yr and older. After hematoma evacuation, patients were randomly assigned to receive either a SDD (SDD-group) or a SPD (SPD-group). The primary endpoint was recurrence indicating a reoperation within 12 mo, with a noninferiority margin of 3.5%. Secondary outcomes included clinical and radiological outcome, morbidity and mortality rates, and length of stay. RESULTS: Of 220 randomized patients, all were included in the final analysis (120 SPD and 100 SDD). Recurrence rate was lower in the SPD group (8.33%, 95% confidence interval [CI] 4.28-14.72) than in the SDD group (12.00%, 95% CI 6.66-19.73), with the treatment difference (3.67%, 95% CI-12.6-5.3) not meeting predefined noninferiority criteria. The SPD group showed significantly lower rates of surgical infections (P =. 0406) and iatrogenic morbidity through drain placement (P =. 0184). Length of stay and mortality rates were comparable in both groups. CONCLUSION: Although the noninferiority criteria were not met, SPD insertion led to lower recurrence rates, fewer surgical infections, and lower drain misplacement rates. These findings suggest that SPD may be warranted in routine clinical practice © 2019 Copyright © 2019 by the Congress of Neurological Surgeons.
引用
收藏
页码:E833 / E834
页数:2
相关论文
共 50 条
  • [41] Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings
    Chen, CW
    Kuo, JR
    Lin, HJ
    Yeh, CH
    Wong, BS
    Kao, CH
    Chio, CC
    JOURNAL OF CLINICAL NEUROSCIENCE, 2004, 11 (07) : 706 - 709
  • [42] The Nelaton Catheter Guard for Safe and Effective Placement of Subdural Drain for Two-Burr-Hole Trephination in Chronic Subdural Hematoma: A Technical Note
    Fichtner, Jens
    Beck, Juergen
    Raabe, A.
    Stieglitz, Lennart Henning
    JOURNAL OF NEUROLOGICAL SURGERY PART A-CENTRAL EUROPEAN NEUROSURGERY, 2015, 76 (05) : 415 - 417
  • [43] The Safety and Efficacy of Dexmedetomidine vs. Sufentanil in Monitored Anesthesia Care during Burr-Hole Surgery for Chronic Subdural Hematoma: A Retrospective Clinical Trial
    Wang, Wenming
    Feng, Lei
    Bai, Fenfen
    Zhang, Zongwang
    Zhao, Yong
    Ren, Chunguang
    FRONTIERS IN PHARMACOLOGY, 2016, 7
  • [44] Hemoglobin Concentration May Affect the Effect of Atorvastin on Chronic Subdural Hematoma After Burr-Hole Drainage at High Altitude
    Wei, Linjie
    Lin, Chi
    Zhong, Mingfeng
    Zhang, Jianbo
    Zhu, Gang
    FRONTIERS IN NEUROSCIENCE, 2020, 14
  • [45] Case Report: Subgaleal drainage removal results in a fatal complication after burr-hole evacuation of chronic subdural hematoma
    Karamani, Lydia
    Januzi, Donjete
    Eckard, Niklas
    Senft, Christian
    Baumgarten, Peter
    FRONTIERS IN SURGERY, 2025, 12
  • [46] Granuloma formation as a late complication of burr-hole surgery for chronic subdural hematoma
    Yang, Chenlong
    Lin, Guozhong
    Zhang, Jia
    Xie, Jingcheng
    Yang, Jun
    BRAIN INJURY, 2024, 38 (01) : 3 - 6
  • [47] Patterns of care: burr-hole cover application for chronic subdural hematoma trepanation
    Velz, Julia
    Vasella, Flavio
    Akeret, Kevin
    Dias, Sandra
    Jehli, Elisabeth
    Bozinov, Oliver
    Regli, Luca
    Germans, Menno R.
    Stienen, Martin N.
    Bellut, David
    Bichsel, Oliver
    Peltenburg-Brechneff, Laurenz
    Esposito, Giuseppe
    Fierstra, Jorn
    Grueter, Basil E.
    Hofer, Anna-Sophie
    Koenue-Leb-lebicioglu, Dilek
    Krayenbuehl, Niklaus
    Kueffer, Alexander
    Neidert, Marian C.
    Oertel, Markus F.
    Rauch, Philip-Rudolf
    Scheffler, Pierre
    Seboek, Martina
    Serra, Carlo
    Stieglitz, Lennart H.
    Smolt, Nicolas R.
    Tosic, Lazar
    van Niftrik, Bas
    Voglis, Stefanos
    NEUROSURGICAL FOCUS, 2019, 47 (05)
  • [48] Factors for predicting recurrence after burr hole drainage for chronic subdural hematoma: a retrospective study
    Gi Jeong Jeon
    Hyun Taek Rim
    Heui Seung Lee
    Jae Keun Oh
    In Bok Chang
    Joon Ho Song
    Ji Hee Kim
    Neurosurgical Review, 46
  • [49] Factors for predicting recurrence after burr hole drainage for chronic subdural hematoma: a retrospective study
    Jeon, Gi Jeong
    Rim, Hyun Taek
    Lee, Heui Seung
    Oh, Jae Keun
    Chang, In Bok
    Song, Joon Ho
    Kim, Ji Hee
    NEUROSURGICAL REVIEW, 2023, 46 (01)
  • [50] Mini-Perforated Craniotomy with Subperiosteal Drain for Evacuation of Chronic Subdural Hematoma: A New Technique and Clinical Study
    Sirinoglu, Deniz
    Sarigul, Buse
    Aydin, Mehmet Volkan
    INDIAN JOURNAL OF NEUROSURGERY, 2023, 12 (03) : 210 - 214